Genital Herpes Questions

[raniol]

To Doctor,

I posted an earlier question regarding molluscum contagiosum that I have been dealing with, but is now clearing up for the most part.  

I was also diagnosed with genital herpes 6 years ago, and it appears that I'm having another outbreak now.  I started experiencing a dull ache in my scrotum, and now have a small rash and blister that has formed on the shaft of my penis.  I'm a little worried about having an herpes outbreak while having molluscums. So I have a few questions:

Is that going to cause additional complications?  
I'm worried that my immune system is completely shot.  (I was just tested recently and I am HIV negative)
I have an older prescription of Valtrex and am not sure what dosage I should take.  I took 1.5 grams total today.

It just feels like what else is my body going to go through :(

I look forward to your answers and any insight.

Thanks,
R

[raniol]

Thank you Doctor.

[H. Hunter Handsfield, M.D.]

The symptoms you describe are not due to herpes, which does not cause "aches in [the] scrotum, legs, lower back, and around buttock".  And "kinda run down and and under the weather" also are not symptoms of recurrent herpes.  The only symptoms of recurrent herpes outbreaks are blister/sores, sometimes preceded for 1-2 days by numbness or tingling in the area where the sores are about to appear.  That's it.  Certainly nothing like you describe.  These symptoms sound mostly like the physical manifestations of anxiety.  You might discuss that possibility with your doctor.

I'm holding you to your statement about this being the last question.  It's certainly my last response on this thread.  Good luck.

[raniol]

My blood work came back positive for HSV-2 antibody.

My last question before closure of this thread is this.

I started feeling aches in my scrotum, legs, lower back, and around buttocks prior to my outbreak which was approximately 1 week ago.  Doctor confirmed looked for lumps, or anything out of the norm around my scrotum.  

Since being on the Valtrex, the ache in my scrotum has almost diminished, but I still feel aches in the rest of the areas listed above.  The herpes sore has just about healed up.

I still feel kinda run down and and under the weather.  Should the symptoms of a recurrent outbreak last this long even when I'm taking Valtrex?

My outbreak symptoms in the past seem to go away once I started a dose of Valtrex, but this one seems to be lingering around.

Thoughts?  

[H. Hunter Handsfield, M.D.]

You need blood test for HSV-1 and HSV-2 antibodies.  That will give the answer.  In general, if someone has to have genital herpes, HSV-1 is "preferred", as it is associated with fewer recurrent outbreaks and less asymptomatic viral shedding, and therefore lower chance of transmission to partners.  If you have had several recurrent outbreaks over the years, then probably you have HSV-2.  If outbreaks have been rare, e.g. if this is only your first or second recurrence, HSV-1 is more likely.

You should not start suppressive antiviral therapy until you know.  Most people with HSV-1 don't need it.  For now, just finish the current prescription (for 3-5 days treatment), which is sufficient to speed healing of the current episode.  Then await the blood test results.

Report back when you have both your and your fiance's blood test results.  I will need both your results and hers in order to provide proper advice, so I won't have any further comments until then.

[raniol]

I don't know whether or not my genital herpes is due to HSV-1 or 2.  I don't believe I said it was one or the either.  I was diagnosed with genital herpes 6 or 7 years ago and I called the clinic who diagnosed me and they said those records are archived, so I would have to order those to see the diagnosis.

I must admit, you have me quite nervous as to finding out which one I have.  Is one much more serious than the other?  Also, how do I go about getting the blood test done, and what do I ask for?

Thank you doctor.

[H. Hunter Handsfield, M.D.]

First, it is crucial that you know for sure whether your genital herpes indeed is due to HSV-2.  What is the basis for your herpes being HSV-2 and not HSV-1?  Second, your fiance needs a blood test for antibody to both HSV-1 and 2, which will tell whether she might already be infected with the same virus type that you have.  If so, she is immune and can't catch it again.  (Infected partners do not "ping pong" the virus back and forth.)  If not, she is susceptible and you can then address how best to prevent transmission and still plan your child bearing.  It isn't difficult; herpes never stands in the way of healthy children; your wife's ObG will confirm that when she has her appointment.  (People are immune to new infections with the same HSV type; therefore couples do not "ping pong" their HSV infections back and forth.)

Assuming you definitely have HSV-2 and she does not, the 3 strategies to prevent transmission are a) no sex if/when you are having an outbreak, b) consistent condom use, and c) suppressive anti-herpes therapy.  Obviously, you can't use condoms at times you are trying to conceive.  But methods (a) and (b), by themselves, usually are very effective.

So report back with the evidence for your HSV-2 diagnosis and the results of your fiance's blood test.  Then I will be happy to give final advice.

[raniol]

Thank you for your reply.  Just wanted to give an update.

I did see an urgent care doctor last night and verified that it was a herpes outbreak.  He has prescribed me 1gram of Valtrex for 1 week.  He seems to think the ache in my scrotum is most likely HSV related, and the ache doesn't seem as bad today since starting my Valtrex regiment, but I don't know if that is just in my head.

I also saw my normal doctor this morning to get a "second" opinion and to get put on suppression therapy as well.

My last questions are more on the future side of things.

My fiance, to our knowledge does not have HSV.  We would like to have children in the near future, and I know there are risks to that.  If you could elaborate on best practices for sex eg.( when can we have sex and if both of us have it, would we just pass it back and forth to eachother, etc...) and future pregnancy eg.( can we safely have children, etc..)

She is going to her OBGYN tomorrow and get more answers, but I would much appreciate any additional info you can provide.

Thanks,
R

  

[H. Hunter Handsfield, M.D.]

Welcome back.  You could have asked this as a follow-up in your previous thread.

Your molluscum and your herpes are not connected and neither one is likely to make the other worse.  In theory, it might be possible to inoculate HSV from your herpes outbreak into an MC lesion, but that is very unlikely.  To be completely safe, it would be a good idea to wash the entire genital area with soap and water once or twice a day (water with soap instantly kills HSV so the washing will not spread the infection), and try to avoid touching the herpes lesions and then handling your MC lesions.  But even if you forget, or decide not to follow these precautions, nothing is likely to happen.

Your immne system is not "compeltely shot".  Herpes outbreaks and molluscum occur all the time in immunologically normal people; almost certainly it is just a coincidence that you had a herpes outbreak at this time.  The ache in your scrotum is not likely to be due to either herpes or MC.

I will not advise you on the dose of Valtrex; that comes too close to practicing medicine from a distance, which I cannot and will not do.  I'll just say that you don't need as much as 1.5 g in a day.  But for actual advice, you'll need to contact the provider who prescribed the Valtrex and/or the one managing your molluscum.  Anyway, if this is your first apparent herpes outbreak in a long time, it would be good idea for it to be directly examined to confirm your self-diagnosis.

This doesn't sound like a big deal to me and shouldn't be a cause of serious worry.  

Regards-- HHH, MD